Preventive Ethics

Preventive EthicsBeyond the Basics

Module 2Prioritizing Among Ethics Issues

Learning Objectives

• Describe the criteria to be considered when prioritizing ethics issues.

• Apply prioritization criteria to ethics issues. • Describe how to address issues that remain on the

tracking tool.

3

ISSUES Link

IDENTIFY an Issue

Be proactive in identifying ethics issues

Characterize each issue

Clarify each issue by listing the improvement goal

Prioritize the issues and select one

4

Tracking Tool:Advance Directives Issue

5

Appropriateness for PE

1 2 3 4 5 6 7 8 9 10 11 12 13

Date Issue Came to Attention of PE (mm/dd/yy)

Source of Issue (1–2 words)

Possible Ethics Issue (who, what, where, when, how much

or how often)

Immediate Action Req’d (Y/N)

Simple Problem/Obvious Solution (Y/N)

Other Program Responsible for This Issue (Y/N)

Ethics Quality Gap

Preliminary Improvement Goal

Appropriate for PE (Y/N)

Best Ethics Practice

Current Ethics

Practice

Ethics Domain

Ethics Topic

Practice Inconsistent with Ethical Standards, Norms, or Expectations (Y/N)

Data Available (Y/N)

If Data Unavailable, Easily Collected (Y/N)

9/15/XX TJC

A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.

N N N SDM ACP Y N Y

Increase assistance to primary care patients who request help with completing an advance directive

Y

Criteria for Prioritizing Ethics Issues

6

Priority for ISSUES Approach

14 15 16 17 18 19 20 21

Alignment with Strategic Goals (L/M/H)

Level of Risk (L/M/H)

Impact on Patient and/or Employee (L/M/H)

Volume or Scope of Effect (L/M/H)

Resources and Time Req’d to improve (L/M/H)

Likelihood of Success (L/M/H)

Time-Sensitive Issue (Y/N)

Refer for Leadership Approval (Y/N)


14. Alignment with strategic goals/priorities

7

14 15 16





15. Level of risk posed to organization

8

14 15 16





16. Impact on patient and/or employee satisfaction

9

15 16 17





17. Volume or scope of effect

10

16 17 18





18. Resources required to improve

11

17 18 19





19. Likelihood of success

12

18 19 20





20. Time-sensitive issue

13

19 20 21




Recommendation

21. Refer to leadership for approval

14

19 20 21




Group Activity InstructionsHandouts 2.1 and 2.2 (25 min)

Individually (15 min)1. Rate 5 ethics issues in Handout 2.1.2. Determine priority of all 5 ethics issues; record in

Final Rankings box at bottom of handout.In groups (10 min)3. Compare and discuss individual rationales for rating

ethics issues.4. Indicate on Handout 2.2 which issues, based on the

ratings, will be referred to leadership for approval.

15

When an Ethics Issue Is Not Selected for a PE ISSUES Approach

• If not the highest priority, ethics issue stays in tracking tool to be addressed at later date.

• Leadership designates different approach. • PE team supports other group in addressing ethics

issue.• If ethics issue doesn’t warrant further involvement of

PE team, PE coordinator closes loop.

16

If Leadership Disagrees with the PE Team’s Prioritization

• Leaders may have additional knowledge and reasoning for adjusting priorities and should provide that rationale during discussion.

• Keep item on list. It will likely be addressed when there is reasonable time to do so, especially if it is unlikely to be addressed through other means.

17

If Leadership Proposes an Issue That Is Not Appropriate for PE• Ask leadership for clarification on what the ethics gap

may be, and use the appropriateness criteria as needed to assist in the discussion and negotiation.

• If it’s clearly not a PE issue, the PEC may recommend other avenues (i.e., who should address the issue).

• If it’s outside the PE team’s area of expertise, make it clear that the team will require specific resources to address the issue (e.g., patient safety, subject matter expert).

• If the issue is appropriate for the ISSUES approach, add it to the tracking tool. 18

Storyboard Progression

19

Advance Directives Issue

VA Facility/Health Care System: VA

Working Title:Shared Decision Making: Completing Advance Care Directives

Date: 2012

Team Members (First, Last Name, Title Role)PEC, QM, Admin, Nursing, Physician, Social Work

Ad hoc Members (First, Last Name, Title Role)SME—ethics consultantProcess owners—MD, Nursing, Clerk, Social Work

Storyboard Progression

20

Advance Directives Issue

IDENTIFY an IssueBriefly summarize the issue and the source.• Ethics Issue (who, what, when, how much):

Issue: A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.

• Source of Issue: The Joint Commission (TJC) survey findings

List the (preliminary) improvement goal.Increase assistance to primary care patients who request help with completing an advance directive.

Describe why the issue was selected as a priority by the preventive ethics team.This ethics issue aligns with strategic goals, is expected to bring significant benefit to patients, and has a high likelihood of success. The IEC agreed with prioritization of this issue and fully supports the team’s addressing this issue.

Takeaways

Prioritizing among ethics issues• Using tools• 7 criteria for prioritizing ethics issues• Rating and ranking issues• Acting on ethics issues not selected for PE ISSUES

approach

21

Module 2

Questions?

Date post:	24-Feb-2016
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Preventive Ethics

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